Pediatric spinal trauma

Spine fractures are rare in the pediatric population. Children have different injury patterns compared with adults secondary to distinct anatomic and biomechanical features in the immature spine. Upper cervical spine injuries are more common in children 8 years or less and lower cervical spine injuries are more common in children over 8 years. Young children have a disproportionately large head and should be transported on a specialized backboard to prevent excessive neck flexion. Initial assessment consists of a thorough history, physical examination and plain radiographs. Normal radiographic variants in the pediatric spine can mimic injury and understanding of these parameters is critical. Unique pediatric injuries include fractures through the synchondrosis, apophyseal injuries and spinal cord injury without radiographic abnormality. Computed tomography or magnetic resonance imaging may be helpful to further evaluate these injuries. Treatment consists of immobilization in an appropriate orthosis or surgical stabilization. A high index of suspicion and systematic evaluation and treatment of pediatric spine injuries can limit morbidity and lead to an improved outcome.